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Cited by 232Child Abuse and TraumaHealth disparities and outcomesChild Welfare and Adoption

Trajectories of childhood adversity and mortality in early adulthood: a population-based cohort study

Rod, Naja H, Bengtsson, Jessica, Budtz-Jørgensen, Esben, Clipet-Jensen, Clara, Taylor-Robinson, David, Andersen, Anne-Marie Nybo, Dich, Nadya, Rieckmann, Andreas·2020·The Lancet
DOI 10.1016/s0140-6736(20)30621-8
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Abstract

Background Childhood is a sensitive period with rapid brain development and physiological growth, and adverse events in childhood might interfere with these processes and have long-lasting effects on health. In this study, we aimed to describe trajectories of adverse childhood experiences and relate these to overall and cause-specific mortality in early adult life.Methods For this population-based cohort study, we used unselected annually updated data from Danish nationwide registers covering more than 1 million children born between 1980 and 1998. We distinguished between three different dimensions of childhood adversities: poverty and material deprivation, loss or threat of loss within the family, and aspects of family dynamics such as maternal separation. We used a group-based multi-trajectory clustering model to define the different trajectories of children aged between 0 and 16 years. We assessed the associations between these trajectories and mortality rates between 16 and 34 years of age using a Cox proportional hazards model and an Aalen hazards difference model.Findings Between Jan 1, 1980 and Dec 31, 2015, 2 223 927 children were included in the Danish Life Course cohort. We excluded 1 064 864 children born after 1998, 50 274 children who emigrated before their 16th birthday, and 11 161 children who died before their 16th birthday, resulting in a final sample of 1 097 628 children. We identified five distinct trajectories of childhood adversities. Compared with children with a low adversity trajectory, those who had early-life material deprivation (hazard ratio 1·38, 95% CI 1·27-1·51), persistent deprivation (1·77, 1·62-1·93), or loss or threat of loss (1·80, 1·61-2·00) had a moderately higher risk of premature mortality. A small proportion of children (36 081 [3%]) had multiple adversities within all dimensions and throughout the entire childhood. This group had a 4·54 times higher all-cause mortality risk (95% CI 4·07-5·06) than that of children with a low adversity trajectory, corresponding to 10·30 (95% CI 9·03-11·60) additional deaths per 10 000 person-years. Accidents, suicides, and cancer were the most common causes of death in this high adversity population.Interpretation Almost half of Danish children in our study experienced some degree of adversity, and this was associated with a moderately higher risk of mortality in adulthood. Among these, a small group of children had multiple adversities across social, health, and family-related dimensions. This group had a markedly higher mortality risk in early adulthood than that of other children, which requires public health attention.Funding None.

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Authors
Rod, N. H., Bengtsson, J., Budtz-Jørgensen, E., Clipet-Jensen, C., Taylor-Robinson, D., Andersen, A.-M. N., Dich, N., & Rieckmann, A.
Affiliations
University of Copenhagen (DK)
Corresponding author
Rod, Naja H
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2020-08
Volume
396
Issue
10249
Pages
489-497
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(20)30621-8
OpenAlex
W3048611576
Cited by
232
References
25
Citations by year
2026: 35 · 2025: 51 · 2024: 40 · 2023: 44 · 2022: 28 · 2021: 30 · 2020: 4
FWCI
10.59
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Funders
Medical Research Council (MR/P008577/1)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Safety Research › Child Welfare and Adoption
Keywords
childhood adversity, adverse childhood experiences, mortality trajectories, material deprivation, poverty, family loss, maternal separation, family dynamics, premature mortality, cause-specific mortality, accidents, suicide, cancer, life course epidemiology, developmental origins of health and disease, family breakdown, Denmark
MeSH terms
Adolescent, Adult, Cause of Death, Denmark, Family Characteristics, Female, Humans, Male, Maternal Deprivation, Mortality, Poverty, Registries, Proportional Hazards Models, Young Adult

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